Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

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rossington
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Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Fri Jul 12, 2019 3:16 am

What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
Last edited by rossington on Sat Jul 13, 2019 1:09 pm, edited 1 time in total.
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Grt2bOutdoors
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Grt2bOutdoors » Fri Jul 12, 2019 4:48 am

What is ALF? A tv show character from the 70’s?
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by UpperNwGuy » Fri Jul 12, 2019 5:56 am

Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF? A tv show character from the 70’s?
I have the same question.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by slick_dealer_05 » Fri Jul 12, 2019 5:59 am

Costs are much lower in other countries. If ours increase, we will move south of the border or relocate to Asia.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by 22twain » Fri Jul 12, 2019 6:02 am

Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF?
Assisted Living Facility?

Our investments had better cover the cost of one if needed, because we have no kids. That's why we're glad we have 45x normal expenses saved in our late 60s, before even taking Social Security into account.
My investing princiPLEs do not include absolutely preserving princiPAL.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Admiral » Fri Jul 12, 2019 6:19 am

You do realize seniors are entitled to Medicare, correct? It's true that it doesn't cover everything, and provisions for specific facilities and in home care are not always sufficient, but most Bhs know this and account for it in their retirement planning. Non-Bhs? Who knows. Likely not.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Watty » Fri Jul 12, 2019 7:38 am

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
1) Medicare supplements that covers most medical costs.

2) Live in an area where assisted living cost are well below the national average.

https://www.genworth.com/aging-and-you/ ... -care.html

It is also important to look at the costs of the different levels of care since basic assisted living is much less expensive than full nursing home care.

3) Have a paid off house that can be sold to pay the gap between my normal retirement budget and assisted living costs. When you go into assisted living most of your other expenses will stop so the if a nursing home cost $80K a year and your normal retirement budget was $60K a year then the increase may not be as dramatic as it sounds.

Our biggest risk is that assisted living might be needed for a long time while we are both still alive and the other living costs don't decrease when long term care is needed.

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rossington
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Fri Jul 12, 2019 4:00 pm

Watty wrote:
Fri Jul 12, 2019 7:38 am
rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
1) Medicare supplements that covers most medical costs.

2) Live in an area where assisted living cost are well below the national average.

https://www.genworth.com/aging-and-you/ ... -care.html

It is also important to look at the costs of the different levels of care since basic assisted living is much less expensive than full nursing home care.

3) Have a paid off house that can be sold to pay the gap between my normal retirement budget and assisted living costs. When you go into assisted living most of your other expenses will stop so the if a nursing home cost $80K a year and your normal retirement budget was $60K a year then the increase may not be as dramatic as it sounds.

Our biggest risk is that assisted living might be needed for a long time while we are both still alive and the other living costs don't decrease when long term care is needed.
You have really thought this out, good advice for a lot of people.

From my own experience dementia/Alzheimer's can rapidly affect a parent, the child(ren) often don't see it coming...especially if the parent lives alone. Life suddenly changes and (as you stated) the costs don't decrease, nothing stays the same...it is an ever evolving complex situation for all involved.

Those who are drawing down their portfolio using the method as the Wiki states:"....or do you want to spend it all and be flat broke just in time for the grim reaper?" might be placing a heavy burden on their kid(s). Just a thought.
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by fennewaldaj » Fri Jul 12, 2019 11:59 pm

At least in my state (Missouri) ~1/2 of assisted living facilities will take medicaid if you run out of money. Basically all of your social security and pensions go to paying the cost medicaid pays a bit for medical care (~300-500 a month). They usually require you to be able to self pay for some length of time. So essentially they make money on you early and lose money or break even later. We just went through this process with my mother in law who only has enough to self pay for ~4 years.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by LilyFleur » Sat Jul 13, 2019 12:28 am

Be sure you have advanced care directives. Be very specific--do you want to be given drugs for pneumonia if you have severe dementia? Do you want a feeding tube? (Patients with dementia often try to pull their feeding tubes out, and it doesn't necessarily prolong life, and it definitely makes the patient more uncomfortable.)

Make sure a trusted friend/family member is able to make sure your advanced health care directive is with you--and followed-- whether you are in the hospital or a nursing home.

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rossington
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sat Jul 13, 2019 4:02 am

fennewaldaj wrote:
Fri Jul 12, 2019 11:59 pm
At least in my state (Missouri) ~1/2 of assisted living facilities will take medicaid if you run out of money. Basically all of your social security and pensions go to paying the cost medicaid pays a bit for medical care (~300-500 a month). They usually require you to be able to self pay for some length of time. So essentially they make money on you early and lose money or break even later. We just went through this process with my mother in law who only has enough to self pay for ~4 years.
Hope all works out with your mother in law.

We as parents should consider at the very least saving a percentage of our retirement portfolio (or maintaining our entire portfolio) so that we give our children the best financial option we can to give them increased flexibility to make healthcare decisions for us when we are no longer able to.
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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rossington
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sat Jul 13, 2019 4:11 am

LilyFleur wrote:
Sat Jul 13, 2019 12:28 am
Be sure you have advanced care directives. Be very specific--do you want to be given drugs for pneumonia if you have severe dementia? Do you want a feeding tube? (Patients with dementia often try to pull their feeding tubes out, and it doesn't necessarily prolong life, and it definitely makes the patient more uncomfortable.)

Make sure a trusted friend/family member is able to make sure your advanced health care directive is with you--and followed-- whether you are in the hospital or a nursing home.
+1...This is a part of the ongoing process that is required on a daily basis. Many people do not realize what it takes to stay fully on top of this.
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by ruralavalon » Sat Jul 13, 2019 8:02 am

Is ALF Acute Liver Failure? No, we have not thought about that and have no plan.

But Assisted Living Facility, and Long Term Care, yes we have thought about that and have a plan.

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
1) We have Medicare Supplement Insurance to cover most deductibles and copays for health care.

2) We pay dental and vision care out of investments.

3) We are signed up with an endowment home for the time when we can no longer live independently, know the price and have enough in investments to pay for this.

4) We own our home outright with no mortgage, so it's value is plan B for Long Term Care.
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sat Jul 13, 2019 11:51 am

ruralavalon wrote:
Sat Jul 13, 2019 8:02 am
Is ALF Acute Liver Failure? No, we have not thought about that and have no plan.

But Assisted Living Facility, and Long Term Care, yes we have thought about that and have a plan.

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
1) We have Medicare Supplement Insurance to cover most deductibles and copays for health care.

2) We pay dental and vision care out of investments.

3) We are signed up with an endowment home for the time when we can no longer live independently, know the price and have enough in investments to pay for this.

4) We own our home outright with no mortgage, so it's value is plan B for Long Term Care.
Can you elaborate on what an endowment home is and how you sign up for one?
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by delamer » Sat Jul 13, 2019 12:08 pm

Retirees with Medicare coverage and a decent supplemental plan are going to be in good shape to handle most medical costs.

The costs for assisted living, memory care, and/or skilled nursing care are a whole other level of expense.

We each have long-term care insurance (3 years of coverage, which will cover 95% of the most common scenarios). Plus we can live comfortably on our pensions and Social Security. So our substantial savings and home equity can be used for long-term care. Unless there is an extreme situation in which both of us end up needing such care for 10+ years, my answer is yes, we can cover long-term care expenses.

I had a co-worker whose mother was in an assisted-living facility for 14 years with progressively-worse dementia. Awful things do happen...

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Broken Man 1999 » Sat Jul 13, 2019 12:17 pm

Medical costs do not worry me all that much.

LTC for me, or DW does worry me a bit.

We have untapped equity in our home that could be extracted via reverse mortgage. We are OK with that, as noone wants to inherit our home, as the family members are very well housed already.

We also have a Variable Annuity that is still growing nicely that can be tapped in a few different ways.

My hope is we never become a burden to our children, but one simply doesn't know what the future holds.

As a result of this uncertainty, any generous charitable gifts will wait until we die.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by TomatoTomahto » Sat Jul 13, 2019 12:37 pm

This topic is frequently discussed without, to my knowledge, a description of what monthly ALF costs are in LCOL, MCOL, HCOL, and VHCOL areas.

What, for example, would a first rate facility near Boston cost monthly?
Okay, I get it; I won't be political or controversial. The Earth is flat.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sat Jul 13, 2019 12:51 pm

TomatoTomahto wrote:
Sat Jul 13, 2019 12:37 pm
This topic is frequently discussed without, to my knowledge, a description of what monthly ALF costs are in LCOL, MCOL, HCOL, and VHCOL areas.

What, for example, would a first rate facility near Boston cost monthly?
This was posted earlier: https://www.genworth.com/aging-and-you/ ... -care.html.
Go to: Calculate the Cost of Care in your area.
Should give you a fairly accurate idea.
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by delamer » Sat Jul 13, 2019 12:53 pm

TomatoTomahto wrote:
Sat Jul 13, 2019 12:37 pm
This topic is frequently discussed without, to my knowledge, a description of what monthly ALF costs are in LCOL, MCOL, HCOL, and VHCOL areas.

What, for example, would a first rate facility near Boston cost monthly?
Person X with $500,000 in a LCOL might be in better shape than Person Y with $1 million in a HCOL, which is clearly your point.

So it is a very individual answer.

My only point-of-reference is $12,000/month for skilled nursing care in a MCOL (3 years ago).

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by TomatoTomahto » Sat Jul 13, 2019 12:58 pm

rossington wrote:
Sat Jul 13, 2019 12:51 pm
TomatoTomahto wrote:
Sat Jul 13, 2019 12:37 pm
This topic is frequently discussed without, to my knowledge, a description of what monthly ALF costs are in LCOL, MCOL, HCOL, and VHCOL areas.
What, for example, would a first rate facility near Boston cost monthly?
This was posted earlier: https://www.genworth.com/aging-and-you/ ... -care.html.
Go to: Calculate the Cost of Care in your area.
Should give you a fairly accurate idea.
Thank you for the link, it was reassuring. I can answer the title question in the affirmative as long as I include non-investment returns (eg, SS, pensions, etc).
Okay, I get it; I won't be political or controversial. The Earth is flat.

delamer
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by delamer » Sat Jul 13, 2019 1:06 pm

TomatoTomahto wrote:
Sat Jul 13, 2019 12:58 pm
rossington wrote:
Sat Jul 13, 2019 12:51 pm
TomatoTomahto wrote:
Sat Jul 13, 2019 12:37 pm
This topic is frequently discussed without, to my knowledge, a description of what monthly ALF costs are in LCOL, MCOL, HCOL, and VHCOL areas.
What, for example, would a first rate facility near Boston cost monthly?
This was posted earlier: https://www.genworth.com/aging-and-you/ ... -care.html.
Go to: Calculate the Cost of Care in your area.
Should give you a fairly accurate idea.
Thank you for the link, it was reassuring. I can answer the title question in the affirmative as long as I include non-investment returns (eg, SS, pensions, etc).
The result from the calculator was reasonably close for my experience with skilled nursing in the MCOL — about 10% too low.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Gnirk » Sat Jul 13, 2019 1:34 pm

delamer wrote:
Sat Jul 13, 2019 12:08 pm


I had a co-worker whose mother was in an assisted-living facility for 14 years with progressively-worse dementia. Awful things do happen...
My mom, who had Alzheimer's and no other health issues, was in a private care home for 8 years. In her case, it was less expensive than a nursing home, with far better quality of care. The cost near the end was over $6,000 per month. Mom was always very frugal, invested wisely, and had the means to pay for her care.

My daughters have told me that the best inheritance I can give them is for me to be able to pay for quality care if/when I need it. And that is what I plan to do.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sat Jul 13, 2019 1:57 pm

Gnirk wrote:
Sat Jul 13, 2019 1:34 pm
delamer wrote:
Sat Jul 13, 2019 12:08 pm


I had a co-worker whose mother was in an assisted-living facility for 14 years with progressively-worse dementia. Awful things do happen...
My mom, who had Alzheimer's and no other health issues, was in a private care home for 8 years. In her case, it was less expensive than a nursing home, with far better quality of care.
The cost near the end was over $6,000 per month. Mom was always very frugal, invested wisely, and had the means to pay for her care.

My daughters have told me that the best inheritance I can give them is for me to be able to pay for quality care if/when I need it. And that is what I plan to do.

Exactly. As I said earler had that same situation. Your reasoning is spot-on. Responsible children know it's your money and will use it to give you the best quality care and life they can (when you no longer can yourself). And they know they can do it because you have saved enough. As tough as it is emotinally for them at least they won't have to worry much about the financial part of it. :beer
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by LadyGeek » Sat Jul 13, 2019 2:21 pm

This thread is now in the Personal Finance (Not Investing) forum (retirement planning).
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by SC Anteater » Sat Jul 13, 2019 2:32 pm

LilyFleur wrote:
Sat Jul 13, 2019 12:28 am
Be sure you have advanced care directives. Be very specific--do you want to be given drugs for pneumonia if you have severe dementia? Do you want a feeding tube? (Patients with dementia often try to pull their feeding tubes out, and it doesn't necessarily prolong life, and it definitely makes the patient more uncomfortable.)

Make sure a trusted friend/family member is able to make sure your advanced health care directive is with you--and followed-- whether you are in the hospital or a nursing home.
This. I don't want any meds if I have dementia etc. No blood pressure pills, no cholesterol pills, nothing.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by ruralavalon » Sat Jul 13, 2019 5:20 pm

rossington wrote:
Sat Jul 13, 2019 11:51 am
ruralavalon wrote:
Sat Jul 13, 2019 8:02 am
Is ALF Acute Liver Failure? No, we have not thought about that and have no plan.

But Assisted Living Facility, and Long Term Care, yes we have thought about that and have a plan.

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
1) We have Medicare Supplement Insurance to cover most deductibles and copays for health care.

2) We pay dental and vision care out of investments.

3) We are signed up with an endowment home for the time when we can no longer live independently, know the price and have enough in investments to pay for this.

4) We own our home outright with no mortgage, so it's value is plan B for Long Term Care.
Can you elaborate on what an endowment home is and how you sign up for one?
An endowment home, in return for payment of a large upfront buy-in (e.g $300k per person) (and assignment of use of Medicare, etc. not certain of details), will undertake to provide your food, shelter and medical care for the rest of your life. It covers the entire spectrum from independent living, to assisted living, to nursing home, to hospice.

Like an insurance company and an insurance policy, the arrangement needs to be actuarilly sound.

Endowment homes are fairly rare compared regular nursing homes, we are fortunate that there are two endowment homes in our small city.

There may be a fee to put yourself on the waitlist for an apartment, in the 2 facilities we know 1 has a fee for the waitlist and the other does not. in the 2 facilities we know of the large upfront buy-in is not due until you are ready to move in.
"Everything should be as simple as it is, but not simpler." - Albert Einstein | Wiki article link:Getting Started

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by bayview » Sat Jul 13, 2019 5:56 pm

^^^ These are frequently known as CCRCs (Continuing Care Retirement Communities.)
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sat Jul 13, 2019 6:02 pm

Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF? A tv show character from the 70’s?
You just made my day!!!!
LOL
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sat Jul 13, 2019 6:08 pm

rossington wrote:
Fri Jul 12, 2019 3:16 am
1
What is your plan?
2
Have you thought about it?
3
If you plan to draw down your retirement portfolio it may be wise to consider this.
1
Most everything that can be taken care of before my demise has been done. Beneficiary deeds, Trusts, etc.
Still working on the Care Directive, though. After that, I'm ready to go.
2
Indeed I have.
Indeed I have.
Threads like these on the forum have my attention.
3
What is ALF? . . or Who is an Alf?

Beyond insurance coverage, etc, etc, I have more than enough to cover what's needed, and leave a legacy.
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sat Jul 13, 2019 6:10 pm

UpperNwGuy wrote:
Fri Jul 12, 2019 5:56 am
Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF? A tv show character from the 70’s?
I have the same question.
About the 70's, Disco, or ALF?
j
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sun Jul 14, 2019 3:59 am

Sandtrap wrote:
Sat Jul 13, 2019 6:10 pm
UpperNwGuy wrote:
Fri Jul 12, 2019 5:56 am
Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF? A tv show character from the 70’s?
I have the same question.
About the 70's, Disco, or ALF?
j
Sandtrap, given your acumen I am really surprised you are having an issue with this:
Assisted Living Facility. (https://www.merriam-webster.com/diction ... d%20living) :oops:
Beyond insurance coverage, etc, etc, I have more than enough to cover what's needed, and leave a legacy.
Now we are on the same page! :beer

(Aren't your care directives stipulated within your trust?)
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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rossington
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sun Jul 14, 2019 4:30 am

ruralavalon wrote:
Sat Jul 13, 2019 5:20 pm
rossington wrote:
Sat Jul 13, 2019 11:51 am
ruralavalon wrote:
Sat Jul 13, 2019 8:02 am
Is ALF Acute Liver Failure? No, we have not thought about that and have no plan.

But Assisted Living Facility, and Long Term Care, yes we have thought about that and have a plan.

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
1) We have Medicare Supplement Insurance to cover most deductibles and copays for health care.

2) We pay dental and vision care out of investments.

3) We are signed up with an endowment home for the time when we can no longer live independently, know the price and have enough in investments to pay for this.

4) We own our home outright with no mortgage, so it's value is plan B for Long Term Care.
Can you elaborate on what an endowment home is and how you sign up for one?
An endowment home, in return for payment of a large upfront buy-in (e.g $300k per person) (and assignment of use of Medicare, etc. not certain of details), will undertake to provide your food, shelter and medical care for the rest of your life. It covers the entire spectrum from independent living, to assisted living, to nursing home, to hospice.

Like an insurance company and an insurance policy, the arrangement needs to be actuarilly sound.

Endowment homes are fairly rare compared regular nursing homes, we are fortunate that there are two endowment homes in our small city.

There may be a fee to put yourself on the waitlist for an apartment, in the 2 facilities we know 1 has a fee for the waitlist and the other does not. in the 2 facilities we know of the large upfront buy-in is not due until you are ready to move in.
Thank you for the information. We are surrounded by many ALF's/Skilled Nursing Facilities in our area but do not know of any endowment homes as you describe...I am interested in checking into this. (Hopefully we both/all of us can avoid this situation until at least the later part of our lives).
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Trader Joe » Sun Jul 14, 2019 6:41 am

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
Yes, my investments will cover all of my needs (and then some). Best of luck.

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Sandtrap
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sun Jul 14, 2019 7:09 am

rossington wrote:
Sun Jul 14, 2019 3:59 am
Sandtrap wrote:
Sat Jul 13, 2019 6:10 pm
UpperNwGuy wrote:
Fri Jul 12, 2019 5:56 am
Grt2bOutdoors wrote:
Fri Jul 12, 2019 4:48 am
What is ALF? A tv show character from the 70’s?
I have the same question.
About the 70's, Disco, or ALF?
j
Sandtrap, given your acumen I am really surprised you are having an issue with this:
Assisted Living Facility. (https://www.merriam-webster.com/diction ... d%20living) :oops:
Beyond insurance coverage, etc, etc, I have more than enough to cover what's needed, and leave a legacy.
Now we are on the same page! :beer

(Aren't your care directives stipulated within your trust?)
Thanks.
Any acumen I might display is/are only brief flashes from the past. . . .
My senior brain is getting AcrOnYm OvERwhELmed.

The "standard" care directives are sorely lacking. I've had family and relatives fall through the loopholes.
Thus, I'm meeting with legal counsel later this year to hammer out a good one as an addendum to my trust.
As "Care Directives" are borderline "Medical Advice" there's no allowance for it on the forum per rules.
I wish there was a way to discuss it without devolving into personal narratives and experiences for all to benefit.

j
Wiki Bogleheads Wiki: Everything You Need to Know

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TomatoTomahto
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by TomatoTomahto » Sun Jul 14, 2019 7:47 am

Sandtrap wrote:The "standard" care directives are sorely lacking. I've had family and relatives fall through the loopholes.
Thus, I'm meeting with legal counsel later this year to hammer out a good one as an addendum to my trust.
As "Care Directives" are borderline "Medical Advice" there's no allowance for it on the forum per rules.
I think “Care Directives” are an increasingly important part of planning for a cohort on BH. Has there been a determination that the mods consider it Medical Advice? DW and I are also hammering out the wording with our estate attorney, and would benefit from a good BH discussion on this topic.
Okay, I get it; I won't be political or controversial. The Earth is flat.

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Sandtrap
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sun Jul 14, 2019 8:25 am

TomatoTomahto wrote:
Sun Jul 14, 2019 7:47 am
Sandtrap wrote:The "standard" care directives are sorely lacking. I've had family and relatives fall through the loopholes.
Thus, I'm meeting with legal counsel later this year to hammer out a good one as an addendum to my trust.
As "Care Directives" are borderline "Medical Advice" there's no allowance for it on the forum per rules.
I think “Care Directives” are an increasingly important part of planning for a cohort on BH. Has there been a determination that the mods consider it Medical Advice? DW and I are also hammering out the wording with our estate attorney, and would benefit from a good BH discussion on this topic.
I think it's not so much the "topic" of "Care Directive" as far as implementation, how to get help with it, things it might include or not to overlook.
But, there's a huge gray area where one might get into CAPA, BIPAP, etc, etc, and then the thread easily devolves into the medical side of things. That's unavoidable if the topic is to be covered thoroughly as I've seen some of this in a good "directive" and the rest are interpretive in the "standard directives" and left to the one with the "Medical Power of Attorney", so therefore, interpretive.

Also, these threads are "close to home" and filled with "personal experience" so then the posts devolve into personal narratives and those include "medical advice topics" so then get eventually locked. I understand that for the most part, a lot of "narratives" are not actionable, per se, and appreciate the work of the moderators to lock threads down that devolve. It's a lot of work for them. Especially as the forum goes through periods with less actionable and more narrative types of posts. Anyway, I digress.

But, as we face "seniorhood", all of these and related topics should be addressed from a financial perspective per forum guidelines. The fact that "Medical Directives" effect financials might be a good way to approach it, perhaps.

I agree with you that these things should have discussions as throrough as "small cap value tilting".

My 02 and ramblings.
j
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by bayview » Sun Jul 14, 2019 8:26 am

Can someone please confirm or not whether "endowment homes" are the same as CCRCs (Continuing Care Retirement Communities)?

I have never heard the term "endowment home", but as explained by ruralavalon in bold below, they sound like CCRCs.

The terminology gets confusing around here. I have also seen "assisted living" as a program where you remain in your own home receiving assistance in your ADLs and other needs, which is certainly different from Assisted Living Facilities. I would have described the former as "home with home health" or some such.
ruralavalon wrote:
Sat Jul 13, 2019 5:20 pm
rossington wrote:
Sat Jul 13, 2019 11:51 am
ruralavalon wrote:
Sat Jul 13, 2019 8:02 am
Is ALF Acute Liver Failure? No, we have not thought about that and have no plan.

But Assisted Living Facility, and Long Term Care, yes we have thought about that and have a plan.

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
1) We have Medicare Supplement Insurance to cover most deductibles and copays for health care.

2) We pay dental and vision care out of investments.

3) We are signed up with an endowment home for the time when we can no longer live independently, know the price and have enough in investments to pay for this.

4) We own our home outright with no mortgage, so it's value is plan B for Long Term Care.
Can you elaborate on what an endowment home is and how you sign up for one?
An endowment home, in return for payment of a large upfront buy-in (e.g $300k per person) (and assignment of use of Medicare, etc. not certain of details), will undertake to provide your food, shelter and medical care for the rest of your life. It covers the entire spectrum from independent living, to assisted living, to nursing home, to hospice.

Like an insurance company and an insurance policy, the arrangement needs to be actuarilly sound.


Endowment homes are fairly rare compared regular nursing homes, we are fortunate that there are two endowment homes in our small city.

There may be a fee to put yourself on the waitlist for an apartment, in the 2 facilities we know 1 has a fee for the waitlist and the other does not. in the 2 facilities we know of the large upfront buy-in is not due until you are ready to move in.
bayview wrote:
Sat Jul 13, 2019 5:56 pm
^^^ These are frequently known as CCRCs (Continuing Care Retirement Communities.)
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by clip651 » Sun Jul 14, 2019 8:34 am

TomatoTomahto wrote:
Sun Jul 14, 2019 7:47 am
Sandtrap wrote:The "standard" care directives are sorely lacking. I've had family and relatives fall through the loopholes.
Thus, I'm meeting with legal counsel later this year to hammer out a good one as an addendum to my trust.
As "Care Directives" are borderline "Medical Advice" there's no allowance for it on the forum per rules.
I think “Care Directives” are an increasingly important part of planning for a cohort on BH. Has there been a determination that the mods consider it Medical Advice? DW and I are also hammering out the wording with our estate attorney, and would benefit from a good BH discussion on this topic.
One or both of you could send a question to the mods, asking if there is a way to discuss the question without breaking forum rules. They may have a suggestion. I would be interested in the topic as well.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by LadyGeek » Sun Jul 14, 2019 8:47 am

Legal issues that have a financial component, such as wills and prenuptial agreements, are permitted. See: Personal Finance Forum Posting Guidelines

We need to keep this forum focused on its primary purpose: investing and personal finance. I believe a Care Directive would not fit within these guidelines.

If there are any questions (or anyone disagrees), feel free to PM me.
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by AerialWombat » Sun Jul 14, 2019 8:51 am

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
I have no known children, no family I’m close with, and anticipate only living to my mid-60’s at best. My medical directives include DNR and “do not treat” for any life-threatening chronic condition. With this, I do not anticipate ever needing skilled care. In the unlikely event it does happen, I would expect that my rental properties will have appreciated enough by that time that they could be sold over time to pay for it. So the financing plan is simply “sell real estate”.

That’s my plan. I recognize that it’s not a plan that most people would choose, let alone even understand. But it creates a high probability that my still-living carcass will never become a financial burden to anybody else.
“Life doesn’t come with a warranty.” -Michael LeBoeuf

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Sandtrap
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Sandtrap » Sun Jul 14, 2019 9:57 am

AerialWombat wrote:
Sun Jul 14, 2019 8:51 am
rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
I have no known children, no family I’m close with, and anticipate only living to my mid-60’s at best. My medical directives include DNR and “do not treat” for any life-threatening chronic condition. With this, I do not anticipate ever needing skilled care. In the unlikely event it does happen, I would expect that my rental properties will have appreciated enough by that time that they could be sold over time to pay for it. So the financing plan is simply “sell real estate”.

That’s my plan. I recognize that it’s not a plan that most people would choose, let alone even understand. But it creates a high probability that my still-living carcass will never become a financial burden to anybody else.
Life has a way of re-adjusting our expiration date.
j
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by ncbill » Sun Jul 14, 2019 12:37 pm

I've had to care for a parent with dementia...they were diagnosed around age 50, dead early 60s.

They spent nearly a decade in bed, requiring total care.

The biggest reason they lasted so long was that I treated every infection they developed...before the last one killed them.

So I've made it clear in my written advanced directive (health care POA) that in the event of dementia or other terminal diagnosis...NO antibiotics, period, palliative care only.

I'm content to let the first infection be the last as I don't want to financially burden my family.

I'm also planning to purchase 3 years LTC coverage for myself, probably 4-5 years for my spouse around age 60.

With my very restrictive health care POA I doubt I'd outlive the coverage.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by drawpoker » Sun Jul 14, 2019 1:23 pm

bayview wrote:
Sun Jul 14, 2019 8:26 am
Can someone please confirm or not whether "endowment homes" are the same as CCRCs (Continuing Care Retirement Communities)?

I have never heard the term "endowment home", but as explained by ruralavalon in bold below, they sound like CCRCs.
Me, too, never heard the term. From the description, sounds exactly like a CCRC with a Type "A" contract, not Type "B".

Could it be the difference is - With the usual CCRC arrangement - there is a choice of refundable (high) or non-refundable (lower) entry fee. Could it be the "endowment home" deal always keeps the money, no refundable options offered?

Just an idea :?

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by drawpoker » Sun Jul 14, 2019 3:24 pm

ruralavalon wrote:
Sat Jul 13, 2019 8:02 am

.....are signed up with an endowment home.......
Noticed you are in Illinois - could this be the one you are referring to, in Peoria?

http://proctorplace.org/

If I am reading it correctly, it seems to say it offers the option of moving in with no big entry fee upfront, just pay monthly charge; or, pay a lump sum upfront and have no monthly fee. And a 3rd choice a combination of both. But site doesn't seem to allow drilling further to get more details.

Also, the housing choices are either apartments or assisted living rooms, no cottages. That differs greatly from most CCRC campuses.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by Doom&Gloom » Sun Jul 14, 2019 4:23 pm

Sandtrap wrote:
Sun Jul 14, 2019 9:57 am
AerialWombat wrote:
Sun Jul 14, 2019 8:51 am
rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
I have no known children, no family I’m close with, and anticipate only living to my mid-60’s at best. My medical directives include DNR and “do not treat” for any life-threatening chronic condition. With this, I do not anticipate ever needing skilled care. In the unlikely event it does happen, I would expect that my rental properties will have appreciated enough by that time that they could be sold over time to pay for it. So the financing plan is simply “sell real estate”.

That’s my plan. I recognize that it’s not a plan that most people would choose, let alone even understand. But it creates a high probability that my still-living carcass will never become a financial burden to anybody else.
Life has a way of re-adjusting our expiration date.
j
+1

The highlighted was exactly my expectation as well. I have blown through that non-barrier with no red flags yet.

As to the OP, my plan is not to outlive my (younger) wife and to be nice enough to her that she will not leave and will keep me at our paid-for home and follow my medical directive which she has been designated to do. I have absolutely no desire to move again--to an ALF or anywhere else.

I can not imagine a worst-case scenario where I would be a financial burden to anybody else. And I really can't imagine anybody going into their own pocket to help pay for my ALF and beyond, given my plainly expressed wishes.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by drawpoker » Sun Jul 14, 2019 4:31 pm

If it's not off-topic - is this a good place to suggest it is probably better to live in one of the states where assisted suicide, not living,
is allowed by law. :|

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sun Jul 14, 2019 4:57 pm

ncbill wrote:
Sun Jul 14, 2019 12:37 pm
I've had to care for a parent with dementia...they were diagnosed around age 50, dead early 60s.

They spent nearly a decade in bed, requiring total care.

The biggest reason they lasted so long was that I treated every infection they developed...before the last one killed them.
So I've made it clear in my written advanced directive (health care POA) that in the event of dementia or other terminal diagnosis...NO antibiotics, period, palliative care only.

I'm content to let the first infection be the last as I don't want to financially burden my family.
I'm also planning to purchase 3 years LTC coverage for myself, probably 4-5 years for my spouse around age 60.

With my very restrictive health care POA I doubt I'd outlive the coverage.
That, is a very interesting decision.
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by AerialWombat » Sun Jul 14, 2019 5:14 pm

Sandtrap wrote:
Sun Jul 14, 2019 9:57 am
Life has a way of re-adjusting our expiration date.
True, but it would take some serious advancements in medical science to overcome my expiration date. So, I just accept it, and enjoy another round. :sharebeer
“Life doesn’t come with a warranty.” -Michael LeBoeuf

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rossington
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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by rossington » Sun Jul 14, 2019 5:31 pm

AerialWombat wrote:
Sun Jul 14, 2019 5:14 pm
Sandtrap wrote:
Sun Jul 14, 2019 9:57 am
Life has a way of re-adjusting our expiration date.
True, but it would take some serious advancements in medical science to overcome my expiration date. So, I just accept it, and enjoy another round. :sharebeer
One day at a time... :beer

About this:
I have no known children, no family I’m close with........... So the financing plan is simply “sell real estate”.
Plan makes sense to me.... but should you become incapacitad in any way do you have an executor, etc. to assist with the RE transactions?
"Success is going from failure to failure without loss of enthusiasm." Winston Churchill.

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Re: Will your investments be enough to cover ALF/misc.medical costs/etc.so there is no burden to your children?

Post by TN_Boy » Sun Jul 14, 2019 8:13 pm

rossington wrote:
Fri Jul 12, 2019 3:16 am
What is your plan?
Have you thought about it?
If you plan to draw down your retirement portfolio it may be wise to consider this.
I don't understand your second question, or the bolded comment. A major part of anyone's retirement planning is figuring out how they will handle medical costs (everybody is going to have these) and how they might handle long term care (many will have such costs, some will not).

For the medical expenses, medicare and supplemental insurance are, I think, most people's answer. For early retirees, it may be more complicated. Dental care, incidentally, can be somewhat expensive for seniors because there does not appear to be much in the way of useful dental insurance for those not in a corporate dental plan.

For long term care, we've had many threads on the merits of LTC insurance, so lots of us are thinking about LTC. I look at the median stay in assisted living, and our investments should handle that for both of us without any problem. Longer stays start to put more stress on the portfolio, but things would get pretty bad (10 years skilled nursing kind of bad for one of us) before it would be a major disaster. I do make the assumption that non-medical expenses (travel, etc) are likely to drop, possibly a lot, in the timeframe that LTC would most likely be needed. If I need assisted living, I'm probably not traveling to Europe, or playing much golf.

And the equity in our house would pay for 3+ years in assisted living in my area.

I do plan to draw down the investment portfolio in retirement ... that is why we saved and invested.

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